What Is Prior Authorization in Health Insurance?

Prior authorization (also called prior auth, pre-authorization, or pre-approval) is a requirement from your health insurer that you obtain their approval before receiving certain medical services, procedures, or medications.

Without prior authorization when required, your insurer can deny coverage for the service — leaving you responsible for the full cost.

What Typically Requires Prior Authorization

• Non-emergency surgeries and procedures
• Specialist referrals (in some HMO plans)
• Brand-name or specialty prescription drugs
• MRIs, CT scans, and other imaging (in some plans)
• Inpatient hospital stays (for non-emergencies)
• Behavioral health and substance use treatment

How to Get Prior Authorization

Usually your doctor's office requests prior authorization on your behalf. Contact your insurer or check your member portal to confirm whether a procedure requires it before scheduling.